Washington Apple Health Long Term Care -Renewals
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Washington Apple Health Long Term Care -Renewals


Revised March 4, 2014



Purpose: This section describes the WAC and policy of the renewal process for long term care programs and Classic Medical programs. Consult the EAZ manual (links below) for the eligibility review process for cash and recertification process for food benefits.

WAC 182-504-0035Washington apple health -- Renewals.

Washington Apple Health Renewals

WAC 182-504-0035

WAC 182-504-0035

Effective October 1, 2013

WAC 182-504-0035 Washington apple health -- Renewals.



(1) For all Washington apple health (WAH) programs, the following applies:

(a) You are required to complete a renewal of eligibility at least every twelve months with the following exceptions:

(i) If you are eligible for WAH medically needy with spenddown, then you must complete a new application at the end of each three- or six-month base period;

(ii) If you are eligible for WAH alien emergency medical, then you are certified for a specific period of time to cover emergency inpatient hospitalization costs only (see WAC 182-507-0115(8)); or

(iii) If you are eligible for WAH refugee coverage, you must complete a renewal of eligibility after eight months.

(b) You may complete renewals online, by phone, or mailed or faxed to us (the agency or its designee).

(c) If your WAH is renewed, we decide the certification period according to WAC 182-504-0015.

(d) We review all eligibility factors subject to change during the renewal process.

(e) We redetermine eligibility as described in WAC 182-504-0125 and send you written notice as described in WAC 182-518-0005 before WAH is terminated.

(f) If you need help meeting the requirements of this section, we provide equal access services as described in WAC 182-503-0120.

(2) For programs based on modified adjusted gross income (MAGI) as described in WAC 182-503-0510:

(a) Sixty days prior to the end of the certification period:

(i) When information from electronic sources shows income is reasonably compatible (as defined in WAC 182-500-0095), we administratively renew your coverage (as defined in WAC 182-500-0010) for a new certification period and send you a notice of renewal with the information used. You are required to inform us if any of the information we used is wrong.

(ii) If we are unable to complete an administrative renewal (as defined in WAC 182-500-0010), you must give us a signed renewal in order for us to decide if you will continue to get WAH coverage beyond the current certification period.

(iii) We follow the requirements described in WAC 182-518-0015 to request any additional information needed to complete the renewal process or to terminate coverage for failure to renew.

(b) If your WAH coverage is terminated because you didn't renew, you have ninety days from the termination date to give us a completed renewal. If we decide you are still eligible to get WAH coverage, we will restore your WAH without a gap in coverage.

(3) For non-MAGI based programs (as described in WAC 182-503-0510):

(a) Forty-five days prior to the end of the certification period, we send notice with a renewal form to be completed, signed, and returned by the end of the certification period.

(b) We follow the requirements in WAC 182-518-0015 to request any additional information needed to complete the renewal process or to terminate coverage for failure to renew.

(c) If you are terminated for failure to renew, you have thirty days from the termination date to submit a completed renewal. If still eligible, we will restore your WAH without a gap in coverage.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

What forms are used for Washington Apple Health Long term care renewals?

Renewals for long term care medical can be completed:

  1. Online through Washington Connections.  Go to "renew by benefits"; or
  2. DSHS 14-416 Eligibility Review for Long Term Care Benefits (used just for Classic Medicaid) ; or
  3. DSHS 14-078 Eligibility Review (used for cash, food and Classic Medicaid reviews); or
  4. By phone.  Contact the HCS financial worker at the local Home and Community Service (HCS) office (link has HCS phone numbers by county).

Eligibility review forms for long term care should be sent to:

HCS Imaging Center - PO Box 45826

Olympia WA  98504-5826

Or FAXED to:

HCS Imaging Center - FAX 1-855-635-8305

Any document mailed or faxed to DSHS should always include a complete name and the DSHS client ID so the document gets assigned to the correct case record. 


First annual review at opening when there is a Community Spouse

A phone review can be completed at the first annual review when there is a community spouse, however it is important that verification that all resources in excess of the $2,000 resource limit are out of the institutional spouse's name and into the community spouses name.

Whether a phone interview, paper or online renewal is completed, request the necessary verifications to document that resources in excess of $2,000 are in the community spouse's name.  Make sure the resources are document on the community spouse's screen in ACES. 

 


Worker responsibilities

At the renewal process, review eligibility elements below for long-term care.  Document where changes have occurred or new information is provided. 

  1. Resource eligibility. 
    1. If the home is owned by the client, check to make sure the home is still in the client's name.
    2. If resources appear within the standards, do not request verification at review unless eligibility is questionable or resources are close to the resource standard.
    3. Verification of life insurance and burial plans are required at application, do not request verification at review unless a new policy is reported or if client has whole life with countable cash surrender value that needs to be verified.
    4. Use prudent person to request verification of any resources that is questionable. 
  2. Income eligibility
    1. Request verification of gross income at renewal only if a change is reported and there is no interface such as social security, veterans, Washington State pension.  Only request verification if the department does not have access to income verification. 
  3. Post eligibility deductions
    1. Request verification of post eligibility deductions such as uncovered medically necessary expenses, guardianship fees, if the client is reporting a change in the amount.
    2. Spousal and dependent deductions
      1. Request verification of spousal income and shelter costs only if the community spouse would receive a spousal allocation.  If changes are reported in spousal income, do not request verification unless the department is unable to verify through an interface such as social security, VA, Washington State pension. 
      2. Request verification of dependent income only if a change is reported.  If the department is able to verify through an interface such as social security or VA, do not request verification. 
  4. If doing a phone renewal it's important to document all eligibility elements including who you conducted the phone interview with and their contact information.   However it is not required that you put remarks behind each screen if no changes or new information is reported.

 


Worker responsibilities - Processing late reviews

ALSTA gives all clients the extra time and consideration they need during the financial eligibility review (ER) process.  We assure clients, representatives, case managers and facility staff all are made aware of the required ER and that benefits will ends if one is not completed.

When an ER is not initiated in ACES by mid-month, deadline alert 214 is generated.  The day after alert 214 appears ACES sends a termination letter to the client and to all representatives coded in ACES to receive letters.  The termination letter does not include another ER form and is not sent to faciltiies onn the INST screen. 

Please note:  Refer to the ACES production calendar for exact dates the 214 alerts are generated.  214 alerts are generated one day prior to when the ten-day advance notice of termination is being sent to the client. 

To ensure we meet EA service requirements for all clients:

  1. Initiate Washington Apple Health Medical reviews only when the following has occurred:
    1. Review is physically received in office; or
    2. Contact is made with the client, authorized representative, or guardian and
      1. You completed a phone interview.  Document the phone review including who you talked to.
  2. When 214 alerts are generated for Washington Apple Health Medical:
    1. Print a list of your 214 alerts
    2. Contact the client, AREP, or guardian by the last day of the certification period.  If contact is made:
      1. Inititiate a phone renewal
      2. Review all eligibility factors subject to change during the renewal process; and
      3. Add remarks on the applicable screesns
      4. Send a Request for Information (0023-01) for questionable verification needed or conflicting information.  Do not ask the clients to provide verification of items we are able to obtain such as social security income, VA income, Washington State pensions. 
  3. ACES will continue to mail ER renewal notices for Washington Apple Health Medical 45 days prior to the client's certification ends date. Completing the phnone renewal is applicable when:
    1. Client, AREP, or guardian makes contact with your anytime during the month of review, or
    2. Client, AREP or guardian has not returned the eligibility review form and you initiate phone contact to complete the review.  Please note:  You do not need to wait until a 214 alert is generated to begin the phone renewal process. 
  4. If unable to contact the client, AREP or guardian, reprint the termination letter.  For Washington Apple Health Medical, send the letter and an ER form with a business reply envelope to:
    1. The client
    2. All authorized representatives
    3. The case manager
    4. The facility representative
  5. If you are unable to reach the client by the 5th of the following month after the certification end date for Washington Apple Health Medical, make a final contact with the client, AREP, or guardian by phone.
    1. If contact is made, initiate the phone renewal process.  Leaving a phone message is not sufficient.
    2. If no contact is made by phone, mail an additional ER request to the client, authorized represenative, case manager and facility.
    3. If contact is made and phone ER is completed, reinstate benefits back to the first of the month, provided services were in place during the time period the case was closed.
    4. Clients have 30 days from the termination date to submit a completed renewal per WAC 182-504-0035.  If client remains eligible, restore their benefits without a gap in coverage.
  6. For cash and basic food.   

The policy described above is for Medical programs.  Some recipients of long term care services are receiving cash and/or food benefits.  Eligibility review requirements for cash assistance and recertification process for food assistance is described in the EAZ manual below.  

  1. Eligibility review requirements for cash assistance are described in WAC 388-434-0005.  
  2. Recertification process for food assistance is described in WAC 388-434-0010. 
    1. Someone can recertify Basic Food benefits by:
      1. Completing DSHS 14-001 (X) Application for Benefits;
      2. Completing DSHS 14-078(X) Eligibility Review;
      3. Participating in the interactive ACES Application for Benefits (AFB); or
      4. Completing the online application.


Follow Equal Access, NSA policies when doing renewals

Equal Access, NSA for long-term care 

Modification Date: March 4, 2014